Im starting my MS4 and going into psych, and I share your mindset. I think it's crucial to separate the micro from the macro. In the micro, you are asking yourself how do I help this person in front of me with the tools I have available (which should be how every doctor thinks) and how do I advocate. In the macro, you are asking yourself what set of tools/programs/ideas/approaches will be the most useful for the largest set of people without violating important philosophical/cultural principles. Very separate, in my view.

I'd even make an argument against the prevailing view that a psychiatrist's only patient interaction modalities should be empathizing, understanding structural problems, and 'not judging'. The best psychiatrist I rotated (psychosomatic focusing on transplant and substance abuse) with was pretty upfront with patients that their behavior was unacceptable, that they had some responsibility for how their treatment course proceeds, etc. The key was she was also always ready to start anew when the patient was ready to try (including handing out her cellphone number to every patient)... and despite some heated conversations, patients almost always profusely thanked her afterwards for this.